经胸一期病灶清除植骨融合内固定术治疗胸椎结核  

One-stage radical debridement and bone graft fusion combined with internal fixation for treatment of thoracic vertebrae tuberculosis via anterior thoracic approach

作　　者：刘继军[1] 刘夏君[1] 左春光 王新虎[1] 王建顺[1] 姚福东[1] 

机构地区：[1]宝鸡市中心医院脊柱外科,陕西宝鸡721008

出　　处：《临床骨科杂志》2010年第5期481-483,共3页Journal of Clinical Orthopaedics

摘　　要：目的评价经胸入路一期病灶清除植骨融合内固定治疗胸椎结核的疗效。方法对28例胸椎结核患者[10例伴有后凸畸形,Cobb角为13～30(22±3)°;16例伴有神经功能障碍]采用经胸入路一期病灶清除植骨融合内固定术治疗,随访观察治疗效果。结果术后Cobb角为2～10(5±3)°,后凸矫正角度无明显丢失,无手术并发症。28例均获随访,时间12～24个月。患者均临床治愈无复发。术后3～8(4.2±1)个月植骨全部融合,内固定无松动、断裂。16例脊髓损害者神经功能Frankel分级:A级1例恢复至C级;B级3例恢复至D级1例、E级2例;C级4例、D级8例均恢复至E级。结论经胸一期病灶清除植骨融合内固定治疗胸椎结核暴露充分,有利于病灶清除、前方脊髓减压、重建脊柱稳定性,植骨融合率高。Objective To evaluate the surgical efficacy of one-stage radical debridement and bone graft fusion combined with internal fixation for treatment of thoracic vertebrae tuberculosis via anterior thoracic approach.Methods 28 patients suffered with thoracic vertebrae tuberculosis,including 10 patients with kyphosis that the Cobb angle was 13-30（22±3）° and 16 patients with spinal cord injury.All patients underwent one-stage radical debridement and bone graft fusion combined with internal fixation for treatment thoracic vertebrae tuberculosis via anterior thoracic approach,the clinical outcome was reviewed retrospectively.Results The Cobb angle was 2-10（5±3）° after operation.The angle of kyphosic correction were not significantly lost.The complications of operation were not found.All patients were followed up for 12-24 months.All patients reached clinical cure without any recurrence of tuberculosis.All patients showed complete bone graft fusion in 3-8（4.2±1）months after operation.No loosening and breakage of internal fixation was found.16 patients with spinal cord injury were evaluated neurological functions through Frankel grade;1 patient with A grade recovered to C grade;1 patient with B grade recovered to D grade;2 patients with B grade recovered to E grade;4 patients with C grade and 8 patients with D grade recovered to E grade.Conclusions One-stage radical debridement and bone graft fusion combined with internal fixation for treatment thoracic vertebrae tuberculosis via anterior thoracic approach is effective in sufficient exposure,lesions debridement,anterior spinal cord decompression,spinal stability reconstruction and acceleration bone healing.

关 键 词：胸椎结核 脊柱融合术 内固定 病灶清除 

分 类 号：R529.2[医药卫生—内科学] R687.32[医药卫生—临床医学]